Gynecology

List of Articles

Managing von Willebrand Disease in WomenBleeding disorders have serious implications for the practice of obstetrics and gynecology. The most common inherited bleeding disorder is von Willebrand disease (VWD), which is caused by a deficiency, dysfunction, or absence of von Willebrand factor (VWF). This disorder is caused by either a quantitative or qualitative defect in VWF. It is a common cause of heavy menstrual bleeding and other bleeding problems in women and adolescent girls. Obstetricians and gynecologists should include VWD and other bleeding disorders in the differential diagnosis when evaluating patients with heavy menstrual bleeding, regardless of age. Available treatment options for adolescents are similar to those for other women. Despite the therapeutic physiologic effect of pregnancy on patients with VWD, bleeding complications remain a significant risk to both mother and fetus. Because the risk of bleeding varies by subtype, accurate diagnosis of the disease is an essential step of care to provide recommendations regarding optimal therapy and genetic counseling. Overall, the preferred management for pregnancy that is complicated by VWD is anticipating complications by monitoring bleeding parameters. Therefore, with adequate monitoring, prophylaxis, and observation, patients with VWD can be expected to tolerate the course of pregnancy with minimal risk. Because of the importance of these guidelines for the practice of obstetrics and gynecology, the information relevant to women's health is summarized here.

Benign Vulvar Skin Disorders: Part 1Nearly one in six women will experience chronic vulvar symptoms at some point, from ongoing itching to sensations of rawness, burning, or dyspareunia. In many chronic cases, more than one entity is the cause. Specific skin diseases, sensations of rawness from various external and internal irritants, neuropathy, and psychological issues are all much more common causes of chronic vulvar symptoms than infections. Vulvar skin disorders can interfere with sexual function because of discomfort, pain, and embarrassment. Chronic vulvar conditions impact not only a womanís sexual well-being but also her overall quality of life. As women become more comfortable with vulvar health, they will seek the advice of their healthcare providers, especially about their sexual health. Gynecologist must be prepared to diagnose and treat vulvar conditions, including chronic vulvar skin disorders. A detailed history and physical examination, backed by a confident knowledge of the vulvar dermatoses, will aid in diagnosis and treatment. Focus of this review is on common benign conditions of vulvar skin: contact dermatitis; lichnoid vulvar dermatoses; extramammary Pagetís disease and squamous cell hyperplasia: their diagnosis and current management.

Menopause: Managing Mood, Memory and Female Sexual DysfunctionsThe review describes the diagnostic criteria, helpful screening tools, and initial treatment guidelines in order to better equip the obstetricians and gynecologists to manage these patients with depressive episodes, memory loss, Alzheimerís disease and female sexual dysfunctions. Sexual concerns should be addressed routinely as part of all comprehensive womenís health visits. Gynecologists are often the first health care provider a woman turns to when seeking help for sexual problems. It is important to provide a safe and non-judgmental environment that facilitates discussion of these issues. Patients and their clinicians can be reassured that for the majority of women, cognitive function is not likely to worsen in postmenopause in any pattern other than that expected with normal aging. Although it not likely that in postmenopause, a womanís cognitive function will return to what it was premenopause, she may adapt to and compensate for the symptoms with time. Stimulant medication may have a role in the treatment of subjective cognitive impairment, particularly for women with comorbid fatigue or impaired concentration who are not showing evidence of objective impairment. There is some evidence that modifying lifestyle factors can decrease the risk of dementia and even cognitive decline associated with normal aging. It is hoped that the continued research into the causes of Alzheimerís disease will provide some of the necessary information about the prevention and treatment of this relentless and socially damaging disease.

Bone Health: Osteoporosis Prevention StrategiesOsteoporosis is an important health problem affecting mature women. Americans with osteoporosis or with low bone mass, approximately 80% are women. Osteoporosis-related fractures will occur in more than 40% of women over the age of 50. Hip fractures will occur in more than 40% of women over the age of 50. An estimated 1.3 to 1.5 million fractures occurring annually are attributed to osteoporosis, accounts for about 15% of the total. Within 1 year after a hip fracture, up to 20% of the victims will die, 25% of the survivors will be confined to long-term care facilities, and 50% will experience long-term loss of mobility. Spinal fractures can be associated with pain, loss of height, and deformities. Osteoporosis also is associated with tooth loss and the resorption of alveolar ridge. Obstetricians and gynecologists play a major role in the prevention, diagnosis, and treatment of osteoporosis as outlined in this document. It is intended as an educational tool that presents current information.